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FILE CONTE~TS SUMMARY
FACILITY :.::ßr-n ré11)r<j r(Y.e.
ADDRESS :..:1 () I Trl j X -t°U 'I'.
PERMIT #: / 5 {)()~é{
ENV. SENSITIVITY: f\{ £8
Activity
Date
Comments
# Of Tanks
OOpl'M.f.ICn
/ KOO.;2;{
(JFpJi(',a+/O YJ
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abo YìdoVJ
aJJa -fldrJ n-e,,f
1700 Flower Street
BakersfiEld, California 93305
Telephob1e (8051861-3636
e KERN COUNTY HEALTH DEPART.T
. HEALTH OFFICER
Leon M Hebertson, M.D.
ENVIRONMENTAL HEALTH DIVISION
DIRECTOR OF ENVIRONMENTAL HEALTH
Vernon S. Reichard
April 29, 1987
Braild Dry Ice. Inc.
101 Truxtun Avenue
Bakersfield. California 93301
Dear Sirs,
Upon review of your recently submitted laboratory results, we have
determined that the extent of the contamination has been adequately
defined. The concentration of contaminants found are below our
recommended action levels. Based upon this information. we consider
this abandonment and assessment complete.
Sincerely,. .,
\-'}1¡£1_"h ~. ß~JVv~k/)
I
Mark J. Pishinsky -
Environmental Health Specialist
Hazardous Materials Management Program
MJP:sw
Delano . Lam"
DISTRICT OFFICES
Lake Isabella . Mojave . Ridgecrest . Shafter . Taft
AE.iRICIJL TUllE
/í'"~W-L'-\: ~---~/ç í :fl. -~ I~í ~. .~
I ¡'-"I - --., . .
1>1';);",;",,-«
CHEMiCAL ANALYSIS
LABORATORIES
INC.
J. J. EGliN. REG. CHEM. ENGR.
PHROLEUM
MAIN OFFICE: 4100 PIERCE ROAD. BAKERSFIELD, CA. 93308 PHONE 327·4911
Purgeable Aromatics
(SOIL)
MCNABB CONSTRUCTION
2616 STARK STREET
BAKERSFIELD, CA. 93305
Date of
REPORT:]-25-87
LAB 1\10.: 4520
Sample Description: BRAND CO UNION AVE
@2'
DATE
SAMPLE COLLECTED:
3-12-87
DATE SAMPLE
RECEIVED @ LAB:
3-13-87
DATE ANALYSIS
COMPLETED:
3-24-87
Benzene
Toluene
Ethyl Benzene
p-Xylene
m-Xylene
a-Xylene
Isopropyl Benzene
Petroleum Hydrocarbons
~g/g
~g/g
~g/g
¡.<g/g
f-Ig/g
¡.<g/g
¡.<g/g
f-Ig/g
Minimum
Analysis Reporting
Results Level
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.10
none detected O. 10
none detected 0.10
none detected 5.00
none detected 5.00
Constituent
Reporting
Units
Total Petroleum Hydrocarbons ¡.<g/g
CALIFORNIA D.O.H.S. 5020/8020: DRY MATTER BASIS
COI"IMENTS:
PETROLEUM HYDROCARBONS: Quantification of volatile hydrocarbons present
(C1 to C20) utilizing a Gasoline Factor. As outlined by the C~lifornia
D.O.H.S. These petroleum hydrocarbons are in addition to the constituents
specifically defined on this report.
TOTAL PETROLEUM HYDROCARBONS: The sum total of all [non-chlorinated]
constituents on this report.
By ___(2-Æ_ß~/-~~---
23. J.~~~
J~/~·· /
:' /CvCwlt ~~
, ----- -----------
Analyst
e
e
LABORATORIES INC.
A6RlCUL ruM
J. J. EGLIN. IIEG. CHEM. ENGII.
CHEMICAL .'MAL YSIS
PErROlEUII
MAIN OFFICE: 4100 PIERCE ROAD, BAKERSFIELD, CA. 93308 PHONE 327-4911
Purgeable Aromatics
(SOIL)
MCNABB CONSTRUCTION
2616 STARK STREET
BAKERFIELD, CA. 93305
Date of
REPORT: 3-19-137
LAB No.: lt519
Sample Description: BRANDCo UNION AVE.
@It'
DATE
SAMPLE COLLECTED:
3-12-87
DATE SAMPLE
RECEIVED @ LAB:
3-13-87
DATE ANALYSIS
COMPLETED:
3-17-87
Constituent
Reporting
Units
Analyses
Results
Minimum
Reporting
Level
Benzene
Toluene
Ethyl Benzene
p-Xylene
m-Xylene
o-Xylene
Isopropyl Benzene
Volatile Hydrocarbons
Total Volatile Hydrocarbons
I-lg/g
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.10
none detected 0.50
none detected 0.10
I-lg/g
I-lg/g
I-lg/g
I-lg/g
I-lg/g
I-lg/g
I-lg/g
I-lg/g
EPA 5020/8020: DRY MATTER BASIS
COMMENTS:
VOLATILE HYDROCARBONS: Quantification of volatile hydrocarbons present
(Cl to C20) utilizing a Benzene Factor. These volatile hydrocarbons are
in addition to the constituents specifically defined on this report.
Total volatile hydrocarbon values may be less than, equal to, or greatèr
than any other constituent, or the combined total.
TOTAL VOLATILE HYDROCARBONS: The sum total of all non-chlorinated
constituents on this report.
B 07/!.J:' /-/ /
y__~~~~L~____
t/Je J . (lEg 1 in
.-;; J77
___~'~~)¿J!:~.!.!:::?,_~
Analyst
170CI Flower Street
Bakersfield. California 93305
Telephone (805) 861-3636
e h._nN COUNTY HEALTH DEPART".
HEALTH OFFICER
Leon M Hebertson. M.D.
ENVIRONMENTAL HEALTH DIVISION
PERMIT POR TEMPORARY OR PERMANENT
CLOSURE/ABANDONMENT OF UNDERGROUND
HAZARDOUS
DIRECTOR OF ENVIRONMENTAL HEALTH
Vernon S. Reichard
PERMIT NUMBER A197-15
FACILITY NAME/ADDRESS:
OWNER(S) NAME/ADDRESS:
CONTRACTOR:
Brand Dry Ice, Inc.
DBA: Brandèo
101 Truxtun Avenue
Bakersfield, CA 93301
Brand Dry Ice, Inc.
UBA: Brandco
101 Truxtun Avenue
Bakersfield, CA 93301
McNabb Construction Company
2616 Stark Street
Bakersfield, CA 93305
License No. 474331
PERMIT TO ABANDON
PERMIT EXPIRES
Au~ust 22, 1987
LOCATION.
APPROVED BY
AUl?;ust 22, 1986
¡ Ii ~ ~
"I' .: ..>¡ ,,'
,)la...\, O. I/h, k..L\~1
Mark'Pishinsky I
Jl TANK AT ABOVE
APPROVAL DATE
. I . . . . . . . . . . . .
. . . .POST ON PREMISES.
. . . . . . . . . . . . . . . . . .
CONDITIONS AS FOLLOWS:
1 . Per m i t tee m u s t 0 b t a i n a Fire U e par t men t per m i t p r i 0 r to i nit i at i n g
abandonment action.
2. All procedures used must be in accordance with requirements of
Standards and Guidelines dev~loped for implementation of Kern County
Ordinance Code. A copy of these requirements' are enclosed wi th this
permit.,
3. A minimum of two samples must be retrieved beneath the center of the tank
at depths of approximately 2' and 6'
4. All samples must be analyzed for benzene, toluene, xylene, and total
petroleum hydrocarbons.
5 . A d vis e t his 0 f fie e 0 f the ti mean d d ate 0 f pro p 0 sed sam p I i n g wit h 2 4
hours advance notice.
ACCEPTED BY
~;2l CJjJ,ff?-
DATE
8þ? !et
DISTRICT OFFICES
Delano . Lamont . Lake Isabella . Mojave , Ridgecrest . Shafter . Taft
~ounty Hedl th DepartmenA
Division of Environmental He~.
1700 Flmver Street, Bakersfield, CA 9330'3
Permit _
Application"'~_
No. of Tanks to be Abandoned
h/¿l? -IS-
I
APPLICATICIII FOR PERMIT FOR TEMPORARY OR PERAANDll'
CLœURE/ABANInIMENl' OF UNDERmOOND
BAZAROOUS SUBSTANCES ST'OR1tGE FN:ILI'lY
C.
~ 91~ Application (Fill Out One Application Per Facili tYl ./ .
(]Temporary Closure/Abandonment ~ennanent Closure/Abandonment
Proj ect: Contact (name, area code, phone): Days fioY" ~~:.:."'¿ -¿"",-> (' Nights ~¡.... ~z.?- -Ib(J[?;'
Facil i ty Narne'~·· //.-:' 41.'/,- ~,r - '¿' ~ ~'~J "'Wr.ð ~'O
Facili ty Address /P/ /'/{XI'?7/f./ A'¡/~ Nearest Cross St. //A./hl)/¡"
T R SEe (Rural Locations Only)
(Wner .;B¿Þ",/.'? ,fi,.,i'?/~ /¿-6 .z~<:,: ..i>£!P ,¿'f/?'-y1~~lJIl) Telephone Jt:.I=- "?:::!.. -~.t.~/
Address /c/ '7Æ::/v ·///Ji'~ , ,A:'.ié~~þ ~ .:-/. 1 /;1/.' Zip ?,.3$~j
Operator ßÄ':.,:/I;''./..>;) .L);é!,¿Af /4;;- ~"'-- .. . Te e~ one
Address ,-'¡ç /-"7/;;':--:~ ~',f-,:~,t) ~/~~ ~"",»/62X;,(/Ë/~/ 0<"'---
Water to Facil i ty Provided by t!M-Ä,f!;V~ ¿í/þ#/S"'¿ r;.
Soil Characteristics at Facility. . SrJ,A/,LJ TO r:.-~¿/
Basis !Eor Soil Type and Groundv.ater Depth. Determinations -;-~'L. .,,: ~\'~ ¡J.~
'T1C2Á.},'7 -, {.òcUS-t, Ú, CA License No. </?tf 55,
<:. Zlp ,(33.;,!'(' Telephone [j~'if.z97
Proposed Completion Date ~______
Ion \ Insurer
ntra 1i. P ,é~ L.+b~ CA License No. - ,
~. Zip <f'3':3I.J8 Telephon:d'Y"l -1./ q¡(
(,I(c Proposed Canpletion Date e (IB~
tiori i -- Insurer
Z"ip t1~7 ð/
Depth to Groundwater 2ðlJ /
A.
B.
Environmen al A
Address I 00 .;
Propos,ed Startif)j Date
Worker· s Canpensation Certl
D.
Chemical Composition of Materials Stored
Tank t Chemical Stored (non-co~rcial name)
I .... ~;?_,-I
tlfL.I¿tJ/!J;£/) rf1/}'tr.;í{! Tir.t;L
Dates Stored
Chemical Previously Stored
(if. different)
/v!~ ~
i~!f1, to /'ff.
to
to
to
A-u((-£. ")LCd-F. ðtu\d~
/
E. Describe Method for Retrieving Samples
Samples Will be Ana
Laboratory That')'1~ll Per~nn Ana~e? of
Addr~ss eft ð7J '.4 E.£ø.E~ ~')) ~j>.
This application for: ~emoval or [] abandonment in place
F.
* *
PLEASE PROVIDE INFORMATION REQUESTED rn REVERSE SIDE OF THIS SHEET BEFORE SUBMITTI~
APPLICATION FOR REVIEW_
ThIS fOL~ has been completed under penalty of perjury and to the -best of my knowledge is true
::n::::;~ ýiÞLC/L--l~~ . Title eú'ycf:0~~ Date
1 hJ2 tie
/ I
1700 Flower Street
Bakersfield, California 93305
Telephone (,B05) 861-3636
.ERN COUNTY HEALTH DEPARTM~
// /. ;;/,/
HEALTH OFFICER
Leon M Hebertson, M.D.
ENVIRONMENTAL HEALTH DIVISION
INTERIM PERMIT
TO OPERATE:
DIRECTOR OF ENVIRONMENTAL HEALTH
Vernon S. Reichard
;:¡
PERMIT#150022C
ISSUED:
EXPIRES.
JULY 1, 1986
JULY 1, 1989
UNDERGROUND HAZARDOUS SUBSTANCES
STORAGE FACILITY
NUMBER OF TANKS= 1
---~-------------------------------------------------------------------
FACILITY:
BRAND CO
101 TRUXTUN AVENUE
BAKERSFIELD, CA
OWNER:
BRAND DRY ICE, INC.
101 TRUXTUN AVENUE
BAKERSFIELD, CA 93301
-----------------------------------------------------------------------
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NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING
AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT
NON-TRANSFERABLE
* * *
POST ON PREMISES
Dl\,TE PERMIT MAILED:
JUL 1 6 '¡936
DÞ.TE PERMIT CHECK LIST RETURNED: '_'
,.t.
--_.~- - . .
- -_._----._-_._~~-_._--_.. - ---...----..........
K~U-:, Ç-,JU ley Health Deparunet1
D1V1Slon of Envirorunental H t.
1700 Flo~~r Street, Bakersf1 d, CA 93305
Permit No
APplicatio.
-- .'~ r~"" ........ ""';. ,...--:
/,~ ;;,/ ....~--
':';;1 -_ 2.?;.~ .)"',~'---
!~
B.
APPLICATION FOR PERMIT TO OPERAT1:: UNDERG {OUND
HAZARDOUS SUBSTANCES STORAGE fACILITl
~ of Applicat.ion (check): -
o New Facility Df>4Ddification of Facility IIIExisting Facility DTransfer of Omership
Ðnergl3ncy 24-Hour Contact (name, area code, phone): Days :;Dr"'-:;;:-'~)(v)f
Nights{,);:"~,~::" -;;riU i l-: i-'-íi)/{/
Facil.i ty Name 2.PfJ/Jð Êru /.:~,::·_5>¿~,/q ¿:e/oJA/l)<~] ~: of, Tanks Ã-: 5 /
Type of Business (check): ÓGasol1ne Station .~Other (describe) fr;:~:¿¡'''!¡L .:.?f;/Æ',¿;'
Is Tank(s) Located on an Agricultural Farm? Dyes I!JNo
Is Tank(s) Used Primarily for Agricultural, Purposes? DYes 1m No "
Facility Address (¡?/ "1"Þt//r~/A/ IJr¿ &1kr:..(':.{;:.t,J 4'3?¿'í Nearest Cross St. lIÆJ/fJN ,.<}t6
T R SEC· (Rural Locations cnly)
OWner /?ÆA)./LJ ..LJ/2.é/ /(:{£ fl¥'(" .iJ75Ã i;/ffltJl(ð Contact Person r4~¡f' &AÞ¿?
Address /p/ ç;;p~l"YroA/ rCPr~ Zip d/t.:s""'3¿Y· Teldphone ~r-)2..2.~;/l'''ó/
Operator S'IP?1'l'/":::' Contact Person _____.
Address //.. Zip ~. Tel,~phone /'
"-
Water to Facility Provided by (J11/-/j:ðRr'f;/..¡:J. uJ;r¡~ âJ. Depth to GroW'dwater IIl.Jf~'Ci(.l,l./
Soil Characteristics at Facility~-; ,.'lA/£) -.).~:.... -rñ r~¡:¡(/_
Basis for Soil Type and Grol.lD:iwater Depth Detenninations ' ÚAJ.c:r1.I¿J.Jr/.U
A.
C.
.',
Contrë:lctor Al/4
Address
Proposed StartiB3 Date
Worker's CanpensationCertification .
CA Contractor IS Uce 15e No.
Zip Tel !phone
Proposed Canpletion I:81
Insure . !/As
/ r/l¡J K:..
o í"/'/Ar/,.)6 - -r;
/1/¡ÇLé X\S
WAS 4"-' 61-/" ,
"'" 7'4,..;¡it-
Ir /. r .
- ¿'or:ar.r¿;; '-' ,J,¿)É~ '
.q å/<¡;)/..-r/ ~ - ~t<!E /J "'D
A'¥'/,.)G <?e:-"SÉd-.s.rr.. ,-,,,,#:.¿ ~
D.
If This Permit Is For Modification Of An Existing Facility, Blie
Proposed ,1///'7
E. Tank(s) Store (check all that apply) :
Tank I Waste Product Motor Vehicle Unleaded Regular
--- Fuel
;
I 0 0 B iii 8
,,';J.iVr!/Sf- _ 0 0 0 0
f ¡i//,:#~"L ' t, 0 ·0 0 B B
. ~ ---.... -
0 0 0
§
c ~,..~~....,-- /¿~ 7: ¡- '. :
1 ~ . ,"':""1"., i
[J .
o fj
B B
F.
Chanical Cantx>si tion of Materials Stored (not necessary for rocltor vehicle fuels)
Tank: Chemical Stored (non-coomercial ..arne) CAS i (if known) Chemical Previously Stored
(if different)
//w
G.
Transfer of OWnership .
Date of Transfer A/A'
Previous Facility Name .
I,
Previous Owner
accept fully all obligations Qf Permit No. issued to
I understand that the Permitt ..~ Authority may review and
modifÿ or tenninate the transfer of the Permit to Ope; ate this underground storage
facility upon receiving this canpleted form.
'Itlis form has been canpleted under
true and correct~.¡ '1
. /I/¿ ./A ¡
. .,-- ::?/J :' ~// _~" .' /
S 19 na tur e ·-:;../YI{{,4~,¿)I <W /,/:?.£J'/"J/
penal ty of
perj ury and to the best of my knowledge is
iiI; ¡ f !
. ;' f
-. / ~ '. .;;;-.r-.
.. _ Title/'(."'~X:"·iiJ --:
ili --
Date ¿J/ I i:;(·v
~-¡' 't.!
.....:J~.:....; .J..:""- j ~'¡c.::;~.c
~-o-:: ~~ì¡... ,_
~ ^-.) . ,.
~
"- -('.;:"'-~..-
TANK !4tL_ (FILL OUT SEPARATE FORM _ ~"CH TANK)
FOR EAŒ SECTION, ŒECK ALL APPROPRIATE BOXES
--
H. 1. Tank is: DVaulted E2Jr-km-Vaulted DIbuble-Wall DSingle-Wall
2. Taml< Material
-Ii) Carbon Steel D Stainless Steel D Polyvinyl Chloride D Fiberg1ass-C1ad Steel
o Fiberglass-Reinforced Plastic D Concrete D Alll1\inum 0 Bronze DUnkoown
o Other (describe)
3. Primary Containment
Dalte Installed Thickness (Inches) Capaci ty (Gallons) Manufacturer
j}l'tt:~:( Î I/IA) /.(-,1·';/(1 Ai / i)/} r} . '; ~ ·/1;; L /h.;J I!i/,~rI,()
4. Tank Secondary Containment
o Double-WallW Synthetic Liner DLined Vault flNone OUnknown
[JOther (describe): Manufacturer:
DMaterial Thickness (Inches) Capacity (Gals.)
5. Tank Interior Lining
-[jRubber 0 Alkyd DEµ>xy DPhenolic DGlass DClay Dlk1lined .l1'1known
DOther (describe):
6. Télnk Corrosion Protection
-UGalvanized DFiberglass-Clad DP01yethylene Wrap OVinyl wrappiBJ
Orar or Asphalt .Unknown ON one OOther (describe): '
Cathodic Protection: ilJNone Drmpressed CUrrent System Dsacrificial Anode System
Describe System ~ Equipment:
7. LE~ak Detection, Monitoring, and Interception .
a. Tank: OVisual (vaulted tanks only) DGrourowater Monitori~ Well (5)
o Vadose Zone Moni toeing Well (s) D U-Tube Wi thout Liner
DU-TUbe with Compatible Liner Directi~ Flow to Monitori~ ~ll(s)*
o Vapor Detector* 0 Liquid Level Sensor 0 Condoctivit;t Sensor*
o Pressure Sensor in Annular Space of Double Wall Tank
o Liquid Retrieval &. Inspection Fran U-Tube, Moni todn::J Well or Annular Space
D Daily Gat1::Jin::J &. Inventory Reconciliation 0 Periodic Tightness TestiBj
-ilNone 0 unknown 0 other
b.. Piping: Flow-Restricting Leak Detector(s) for Pressurized Piping-
o Moni toring Sunp wi th Raceway D Sealed Concrete Raceway
D H.a1f-cut Canpatible Pipe Raceway 0 Synthetic Liner Raceway 0 None
f.i!i Unknown 0 other
*Describe Make &. Model:
8. Tank Tightness
"HilS Tins Tank Been Tightness Tested? DYes iitNo DUnknown
Date of Last Tightness Test Resul ts of Test
Test Name Testing Company
9. Tëmk Repair
Tank RePai red? 0 Yes ~No DUnknown
Date (s) of Repair (s)
DE~scribe Repairs
10. Overfill Protection
.~perator Fills, Controls, &. Visually Monitors Level
DTape Float Gat1::Je DFloat Vent Valves 0 Auto Shut- Off Controls
B~:~;t~~;/;T~Se~~5:; ~~a,:;;¡'1~;~:;~:;x/~2-~~he Li~unMa~~ Model For Above Devices
J
11. P i.£!!!9.
a.. Underground Piping: æYes DNa DUnknown Material
Thickness (inches) ¿I.IIr;";<Nv:'hDiameter 1~.r/.",'I~Man..Jfacturer
DPressure IlJsuction DGravi ty . Approximate Length of Pipe RiJ\
b. Underground Pipinj Corrosion Protection :
,{IPy'xZ:.,yr-:;/ :::::.OGa1vanized DFiberg1ass-Clad Otmpressed current DSacrificial Anode
/.:k,' DPo1yethylene Wrap OElectrical Isolation OViny.l Wrap DTar or Asphalt
IiJUnknown o None Dather (describe):
c. Underground Pipinj, Secondary Containment:
DDoub1e-wall DSynthetic Liner System :?ßNone DUnknown
DOther (describe):
_.~---_.
¿ë ern lC.
TANK! ~ (FILL OUT ~EPAPA,'fE FORM __ EACH TANK)
FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES
\c, .-
l'#.J. .I......,; ....,
-' ';:oc:..~ "--'
lac 11 i. l.'1 L'.Jámc:
H.
(
Lî
(\
'V
\..t.\
t'\.."
~",
'- 5.
\ )
~ 6.
~
\.
':1 i
,',!
~.
~
1
t ,
\1\
.'0
~
~
\:
\ 8.
.~
~
"\ 9.
1<
~<;. 10.
.~, .
~:
--
Tank is: D.Vaulted a!lNon-Vaulted OI:buble-Wdll DSingle-Wa-I'í
Tañk Material
!i1carbon'Steel DStainless Steel DPolyvinyl Chloride
10 Fiberglass-Reinforced plastic 0 Concrete 0 All.l1\lnt.ll\
IJ Other (describe)
3. Primary Containment
Date Installed Thickness (Inches)
Li.(,~'¿/'..'WÜ/Áj . l/l./;<'d/(//t/A /
4. Tank Secondary Containment
10 Double-Wall U Synthetic Liner
DOther (describe):
o Material
Tank Interior Lining
[jRubber D Alkyd D~xy OPhenolic",,-DGlass DClay DU11ined æt.l1known
DOther (describe): :-J
Tank Corrosion Protection " .,
iITGalvanized DFiberglass-Clad ,D~lyethylene Wrap OVinyl WrappiBJ
10Tar or Asphalt -liUnknowo DNoneDOther (describe): '
Cathodic Protection:' ..f2INone DImpresSed CUrrent System I:1Sacrificial Anode System-
Descr1te System && Equipnent :~. .\ ;
7. Leak Detection, Monito~'Ìng, and Interc.eption .
a. Tank: DVisual (vau).ted tanks·only¡) DGrourowater Monitorirq We11(s)
o Vadose Zone Moni t:qring Well (s) ,'0 U-Tube Wi thout Liner
o U-Tube with canpatible Liner Directirr¡ Flow to Monitorirq we11(s) *
o Vapor Detector* 0 L.~'quid Level Sensor 0 Condocti'¡it;t Sensor*
D Pressure Sensor in· Arlq,ular Space of Double Wall T.mk
o Liquid Retrieval && Insþection Fran U-Tube, Moni to~ing Well or Annular Space
o Daily Gau;¡iBJ && Inventory Reconciliation 0 Periodic Tightness TestiBJ
o None D Unknown' 0 Other '77:/./.I -T;}4/¿ 4.L/lA/ûJA./r: I) /~'(:??
b. Pi piBJ: Flow-Restricti~ Leak Detector (s) for Pres:,mri zed Pipin;(
o Moni toriBJ SlInp wi th Raceway 0 Sealed Concrete R1cew:sy
o Half-CUt Canpatible Pipe Raceway D Synthetic Lin.~ RacewayJØNone
o UnknoW'l 0 Other
*Descri~ Make i Model:
Tank Tightness
ltiis 'nus Tank Been Tightness Tested?
Date of Last Tightness Test'
Test Name
Tank Repa j r.
Tank RePaired? DYes ,~
Date (s) of Repair (s)
Describe Repairs
OVerfill Protection
[JOperator Fills, Controls, && Visually Monitors Level
~'\. OTape Float Gau:Je DFloat Vent Valves D Auto Shut- Off Controls
"'. iB Capaci tance Sensor 0 Sealed Fill Box DNone .,mllJnknowo
Other: List Malœ && Model Por Above Devices
.\..
1.
2.
.¡ "\
'0 Fiþerglass-Clad Steel
(}Bron ze i! Unknown
Manufacturer /
j/,tJ.<;,(1Y Itl /;./
capacity (Gallons)
,,' .
,,/, ./" ;f^/
;://f/~~/;"',:/./f./ <!,\.
o Lined Vaul t œI None m Unknown
Manufacturer:
Capacity (Gals.)
--
Thickness (Inches)
DYes ~h-i:> DUnknl)wn
Résul ts of Te:3t
Testing Canpany
OUnknown ~ ~ ¿; n '. :' / "lYJ/r /,r" r'
/rr't ,C /1;eAA./ /i /, r,/;,:://
~?
/!J:rì ,
..,
: ..."
" \"',
.~\
P'i~ c". // /..., / ,
, a. . Underground Pi ping: 0 Yes DNo DUnknown Material /(./., ·/t~
',,- Thickness (inches) Diameter Manufacturer
" OPr€'3sure OSuction [jGravi ty . Approximate Lengt:h of Pipe RLI'\
b. ',Underground Piping Corrosion Protection :
"\DGalvanized DFiberglass-Clad DImpres~ed CUrrent: OSacrificial Anode
DPolyethylene Wrap DElectrical Isolation Dviny:.......wrap DTar or Asphalt
DUnknown DNone Dather (describe): A/·-::U-:b~
c. Underground Piping, Secondary Containment:
DDouble-Wall DSynthetic Liner Systerr! :JNone .··Ollnknown
Dather (describe): .._/{~~,;Jj/<.="-